Acta Gastroenterologica Latinoamericana最新文献

Hemangiomas are benign vascular tumors, whose origincomes from the embryonic mesodermal tissue remains. The liver is the most common location. Its location in the teresligament is extremely rare. This is a 59 years old male admittedbecause of episodes of epigastric pain for six months.A CT scan and MRI demostrated a 2 cm diameter lesionlocated near the Teres ligament. Laparoscopic resection wasperformed. Hemangiomas are the most common benign solidtumors located in the liver. They represents 73% of all benignliver tumors. MRI is the imaging of greater certainty fordiagnosis. The Teres ligament (ligamentum teres hepatis) isa fibrous cord resulting in obliteration of the umbilical vein.The location of hemangiomas in this region is extremely rarebut should be considered and should make the differentialdiagnosis with a pedicled hepatic hemangioma or gastointestinalstromal tumors.

We describe a clinical case of a kidney transplant patient whopresented a sudden elevation of his liver function tests. Oncewe ruled out the most frequent causes of acute hepatitis, serumtests for Hepatitis E were performed. Hepatitis E virusRNA was detected in blood and stools. After six months thevirus was still detected. Ribavirin treatment was initiatedwith normalization of the serum aminotransferases and sustainedvirology response was achieved.

90% of cases of intestinal obstruction caused by intestinalmalrotation occur in children under 1 year of age, beingvery uncommon in adults. A female patient of 27 years ofage consults with abdominal pain, vomiting, abdominal distention,dehydration and signs of severe malnutrition. After EGDS, CT scan, and 48 hours of clinical expectation, surgicalintervention was decided with diagnosis of high intestinalobstruction. Intraoperative finding was no intestinal rotationat all. Ladd´s technique was performed together withprophylactic appendectomy. Postoperative evolution wasfavorable. The rare presentation in adults motivates the presentationof this case.

The following is a case report involving a 16 year old femalewith trichotillomania as an antecedent. This patient presentedto the Emergency Room with a chief complaint of earlysatiety and persistent abdominal pain for the past 3 months.However, recently her abdominal pain has worsened and itis now complicated by nausea and vomiting. The physicalexam was notable for epigastric pain on deep palpation. Thebiochemical analysis and abdominal ultrasound were otherwiseunremarkable. An esophagogastroduodenoscopy wassubsequently performed where a trichobezoar was discovered.It extended from the gastric fundus to the third portion ofthe duodenum. A surgical extraction of the trichobezoar wasthen performed. The trichobezoar was found to be 130 cmin length and 8 cm wide at its most cephalad aspect. It isimportant to note that they also found five mall perforationsthroughout the duodenum and jejunum. The patient wasdischarged with outpatient follow up with psychiatry. In thisreport we describe the case of a patient with Rapunzel syndromethat was complicated by small bowel perforation andwe provide a review of the salient literature concerning thissyndrome and its associated complications.

International evidence show that screening for colorectal cancer is cost-effective; however, in Argentina is unknown.

Objective: The study shows the results of a cost-effectiveness evaluation based on two alternative mechanisms: annual faecal immunochemical testing (FIT), and colonoscopy every ten years in Argentina.

Methods: The study develops a Mar- kov model in ten stages, based on information provided by the INC, prior literature review and on-line questionnaires to physicians enrolled in the four major scientific societies related to cancer. Cost information arrived from the Na- tional Superintendence of Social Health Insurances and a sample of managers in social and private insurance schemes.

Results: The most cost-effective strategy consisted annual FIT, in comparison no intervention and colonoscopy every 10 years. The incremental cost effectiveness ratio (ICER) of FIT versus no intervention was of 980.5 pesos per QALY The findings were robust to deterministic sensitivity analysis.

Conclusions: We confirmed that screening for CRC is a cost-effective intervention. Whereas the CCR is one of the leading causes of mortality in Argentina, these results support the widespread use of screening for CRC using anual FIT which proves to be highly cost effective for the country.

Zenker's diverticulum (ZD) is an acquired protrusion of the esophageal wall. Treatment is reservedfor symptomatic cases. In Argentina, ZD has historically managed exclusively by surgical intervention. In 1995, Ishioka, et al and Mulder, et a1published their experience using flexible endoscopes for diverticulotomy. Since then, a wide variety ofdifferent techniques have been published. Objetive. To present technique modifications and results ofour center.

Material and methods: We reviewed the database of57patients (36 men), with a mean age of 71.9 years (range 37-98), with symptomatic Zenker ' diverticulum, who underwent endoscopic myotomy, from December 1997 to April 2015. All procedures were performed in our center, by the same endoscopist (HM). The most common symptom was dysphagia (94.7%), which was recorded by a 0-4 score (0=no dysphagia, 1 =solids, 2=semisolids, 3=liquids, 4=saliva). The first nine cases were done exposing the septum with a nasogastric tube, and the others with a soft diverticuloscope. Allprocedures were carried out with the patient under deep sedation, adminis- tered by an anesthesiologist. A myotomy was done in all cases with a needle-knife, using a coagulation current, to prevent bleeding. Clips were placed to close mucosalilaps, decrease the risk of unsuspected perforation and postprocedure bleeding.

Results: Seventy procedures were performed, in 56 patients. One patient was excluded because of incomplete myotomy due to a severe adverse event. Ninety-eight percent ofpatients had resolution or improvement of the dysphagia score, at 30 days. Three patients with regurgitation as their sole complaint completely resolved their symptom. Median follow-up was 25 months (1-99). Thirty-seven patients were followed for at least 1 year and 97.3% showed a favorable outcome. In 13 cases (22.8%) a reintervention was needed, with positive results in all cases. Bleeding occurred in one patient (1.4%), who required surgery. Another patient required surgical intervention due to technical issues. There were no perforations or infections.

Conclusion: Treatment of ZD with flexible endoscope is a safe and effective option, with good long-term results. We need randomized clinical trials comparing different therapeutic options to be able to recommend a definitive strategy. Until then, we suggest using the technique with which each center has the most experience and feels most comfortable performing.